Maximum Use of the Anterior Maxillary Buttress in Severe Maxillary Atrophy with Tilted, Palatally Positioned Implants: A Preliminary Study

Purpose: To evaluate an alternative treatment for rehabilitation of the atrophic maxilla with palatal and tilted implants and to assess patient satisfaction with the results. Materials and Methods: A retrospective case study was made of completely edentulous subjects with tilted, palatally positioned implants in the anterior maxillary buttress placed and loaded between January 2005 and January 2007. Patients with severely resorbed edentulous maxillae (Class V according to Cawood and Howell) who requested overdentures and were followed for 12 months after implant loading were included. Mesial and distal implant bone loss was measured on panoramic radiographs. Subjects indicated satisfaction with the new prosthesis after 12 months on a visual analog scale. Results: Twelve patients treated with tilted and palatal implants in the anterior maxillary buttress were included in the study; 48 implants were placed (4 implants in each patient) to support 12 overdentures with bars. One implant failed, resulting in a survival rate of 97.9%. The mean peri-implant bone loss of implants with palatal anchorage after 1 year of loading was 0.78 ± 0.5 mm. All patients had stable prostheses at the end of the observation period. Patients were satisfied with comfort and stability, ability to speak, ease of cleaning, esthetics, and function of the prosthesis. Conclusion: Placement of implants slightly to the palatal and tilted in the anterior maxillary buttress to support an overdenture with bars may be a viable treatment alternative for the rehabilitation of the atrophic maxilla, providing a high level of satisfaction with the prosthesis and reducing patient morbidity and costs. Keywords: anterior maxillary buttress, maxillary atrophy, overdenture, palatal position, tilted implants, visual analog scale